The Altarum Institute and its partners are pleased to submit this response to the Grant Opportunity provided by the Agency for Healthcare Research and Quality (AHRQ) by focusing the proposed Partnership for Quality on application of Modeling and Simulation Informatics to enhance both Rural and Urban Health Systems Homeland Security and Readiness. The United States faces a shortfall in our ability to quantitatively assess the robustness of the U.S. medical infrastructure in responding to various terrorist threats or combinations of these threats. Simulation modeling provides a tool for considering these complex scenarios, which literally cannot be solved through actual experimentation due to cost, logistical or other considerations. Under this grant application, Altarum and its partners, the Michigan Center for Biological Information, the University of Michigan Department of Emergency Medicine, and the Texas Community Emergency Health Care Initiative (CEHI) propose testing a simulation model called the Healthcare Complex Model (HCM) for its utility and validity to support bioterrorism readiness planning. We propose that during Phase I, we test and validate the HCM's ability to support planning for a rural healthcare network and identify further enhancements needed in the model for urban settings. In first year of Phase II, we propose that modeling capabilities be enhanced by applying the HCM in an actual urban scenario with our partners in Michigan. In Phase II years 2 and 3, we propose further testing with increasingly larger and more complex networks under different bioterrorism attack scenarios. One of the significant benefits from this Grant will be objectively documented outcomes and outputs which are derived from the application of HCM (under our study rural vs. urban setting) in terms of delivery system, staffing, supplies, patient flow, etc. Such information will prove useful to develop a consistent and coherent framework for biodefense preparedness training by forming the basis of the useful "case studies" for the full range of training modalities employed and reviewed in the AHRQ Evidence Report # 51 and could mitigate the effect of inconsistent objectives and methods from the heterogeneous training by building more consistent training curricula as well as content.